From Code Blue to Medical Musician

The first time I experienced a Code Blue, the hospital code indicating that a patient needs immediate resuscitation, I wasn’t consciously aware of it. That Code Blue was for me.

It was the night of July 16, 2009, immediately following major surgery. I went into anaphylactic shock and minutes before arriving in the Surgical ICU at New York City’s Mount Sinai Beth Israel hospital, I was clinically dead: no heartbeat or respiration. A great medical team resuscitated me that night, but my condition remained critical. I was put into a medically induced coma. No one expected me to survive.

The music didn’t wake me, but it stabilized me, reversing my terminal condition.

Three days later, still in the coma and near death, something happened that started me on the journey I’ve been on these past eight years. My wife, Wendy, had an epiphany that only music could spark my will to live. She received permission to play my favorite Bach piece for me via my iPod – the St. Matthew Passion – and it worked. The music didn’t wake me, but it stabilized me, reversing my terminal condition.

After another three days, now out of the coma, I found out what had happened. I knew I had to give back. I had no money to donate, but I did have my guitar. The director of the SICU, Dr. Marvin McMillen, was already familiar with the power of music to heal, and offered me another way to express gratitude. He gave me permission to return to his SICU as a musician.

Fast-forward eight years – with over 1800 hours of clinical and didactic experience, including many other Code Blues – I recently became the first Certified Medical Musician, and with that title, I was accepted as a member of the Society of Critical Care Medicine.

Those hours of experience were all spent in ICUs, and the most important training period took place over the first three years working with Dr. McMillen and the other doctors and nurses in the SICU where I was saved. They were incredibly helpful in answering the many questions I had. After our years of work together, Dr. McMillen and I have defined “medical musician” as a professional, concert-level musician, with pertinent critical care medical training, who is a member of the medical team in an ICU.

In the 1980s, MRI and CT scans revealed that music activates more of the brain than any other stimulus.

Part of the inspiration for our work came from the knowledge that, throughout history, music has been integral to the healing arts in all known human cultures. By the 19th century, though, as the medical profession became more driven by science and data, music lost its place. Ironically, it is science that has helped bring it back: In the 1980s, MRI and CT scans revealed that music activates more of the brain than any other stimulus. Music increases the production of chemicals like serotonin and dopamine, which aid the healing process. That is the key to understanding music as medicine.

So what exactly does a medical musician do? I often tell people it’s easy to describe what I do, but hard to do it. I’ll walk you through a typical round.

When I first arrive in the SICU, I spend a few minutes getting a sense of the atmosphere and mood of the day. Is it busy and stressful for patients and staff? One of those slow days? Somewhere in the middle? These are all indicators for potential repertoire. Next, I go to the nurses’ station to look at the vital signs for each patient, where I may also consult with doctors or nurses who have specific patients in mind.

I’m then ready to get out my guitar and take another walk through the unit, this time playing very softly. This accomplishes two things. First, a comparison between the data I saw on the computer and the patient’s physical condition is often very revealing. Bad numbers don’t always mean the patient is in bad shape; good numbers don’t necessarily mean they are in good shape. You don’t know until you’ve made a thorough evaluation. Second, this allows the patients to hear a sample of the music. We learned early on that many more patients would request music if they had a chance to hear the musician during the stroll. By the time I’ve completed this process I have a sense of which patients to go to first.

Then the hard part begins. Very few patients will be able to tell you what they want to hear. They may be sedated to deal with pain, or so exhausted that the effort to answer a question is too much. They may even be in a coma, as I was. So the medical musician must have a wide-ranging repertoire of classical, popular and world music. Then, through observation and intuition developed from experience, you try to find the “resonance frequency,” as I call it, of that patient. If you’re successful, you can have a significant effect on the healing process.

Although music is making a comeback in hospitals, there are still healthcare professionals who are skeptical about music used as medicine, and that can be a real problem. This is my favorite anecdote about how I was once able to win over one of those skeptics:

Andrew Schulman takes a break from one of his sessions to pose with patient Christopher Chase.

I’d recently joined the critical care team at Berkshire Medical Center, and there was a nurse who was clearly uncomfortable about having music in the unit. I’d gone to a bedside where the patient’s blood pressure was very high, in the 160s. After I played for twenty minutes, his blood pressure dropped to 125. The nurse paid no attention, thinking it had nothing to do with the music. The next day, I played for another patient with the same result: a big drop in blood pressure from the 160s to the 120s. This time, I had the nurse’s attention. On the third day, at yet another bedside, the same thing happened. This time, the nurse came over to me after I finished and said, “Andrew, could we go to bed two now?”

When the medical staff sees you are helping their patients, you are accepted into the fold. Success begets membership.

Now, I’m often asked what the difference is between a medical musician and other specialties in the field of Music and Medicine. Music therapy is the best known of these. It has often been described as a form of psychotherapy with music as the primary tool, but music therapists address a wide range of health issues. I did consider becoming a music therapist early on, but it would have involved going back to school for two years for the broad training that the program requires. I was 57 at the time, still active as a performing musician (as I continue to be), and I knew my area of interest was only critical care. So the question was, if I wasn’t a music therapist, what was I? Within moments, the words came to mind: medical musician. I would use my experiences as a professional musician and a former critical care patient guided by on-the-job training from the people who’d saved my life.

The idea was always to expand the medical musician program that Dr. McMillen and I started developing. A major consideration on my part was that it could help the careers of many of my fellow musicians around the world. This past summer we held our first workshop, “Medicine for Musicians,” at Berkshire Medical Center. What we look for in the people we train is a high level of musicianship, years of experience as a professional performer, empathy, the ability to work as a team member and the cognitive ability to rapidly respond to medical information. A good sense of humor helps, too.

Additionally, I founded the Medical Musician Initiative, now in the process of becoming a 501(c)(3) non-profit organization. Our mission statement reflects our desire to see medical musicians in every ICU in the world: a bold statement, but it comes directly out of a landmark study published in the August 2015 issue of The Lancet, a leading medical journal. This study was a meta-analysis of 73 studies done over a seven-year period; the conclusion of the report stated, “We believe that sufficient research has been done to show that music should be available to all patients undergoing operative procedures.”

So what is my advice for a musician who wants to follow a similar path? At the end of my first year doing this work, I had some questions for a doctor about why the music I was playing had a beneficial effect for another Code Blue patient. His answer was simple. He didn’t know! But what he said has always stayed with me:

3 Responses

What an inspiring story! As performers, it’s easy to get into the music for only ourselves and forget what it enables us to do for others. I’d love more info on the NPO, but the link is expired; is there somewhere else to look?

Thanks for making my day, Laken! I’m working on getting the Medical Musician website developed. Right now there is only the link to my book and that nice photo with a patient. I hope to have more up soon. Very happy to see you are interested in this field. Best regards, Andrew